BACKGROUND: Relapsing primary central nervous system lymphoma carries a poor prognosis when treated with conventional chemotherapy with a one-year overall survival of 25-40%. Encouraging results have been shown with intensive chemotherapy followed by autologous hematopoietic stem cell rescue. We report the results of a large multicenter retrospective analysis of intensive chemotherapy followed by hematopoietic stem cell rescue in immunocompetent adult patients with primary central nervous system lymphoma or intraocular lymphoma after the failure of high-dose methotrexate-based treatment. DESIGN AND METHODS: Patients were included if they received intensive chemotherapy with a combination of thiotepa, busulfan and cyclophosphamide. Seventy-nine patients (median age 52.4 years, range 23-67 years) were identified. All of the patients except 5 received a salvage treatment after the failure of high-dose methotrexate. After salvage treatment and just before intensive chemotherapy followed by hematopoietic stem cell rescue, 32 patients were in complete response, 26 patients were in partial response, 2 patients had stable disease and 19 patients had progressive disease. RESULTS: With a median follow up of 56 months, the 5-year overall survival probability was 51% in the whole population and 62% among patients who were chemosensitive to the salvage treatment. The 5-year event-free survival probability was 37.8% in the whole population and 43.7% in the chemosensitive subpopulation. Neurocognitive assessments in a subset of patients suggest no evidence of intensive chemotherapy-induced neurocognitive decline. CONCLUSIONS: Thiotepa, busulfan and cyclophosphamide-based intensive chemotherapy is an effective treatment for refractory and recurrent primary central nervous system lymphoma in chemosensitive patients up to 65 years of age. The role of intensive chemotherapy followed by hematopoietic stem cell rescue in chemorefractory patients needs to be more accurately defined.
BACKGROUND: Relapsing primary central nervous system lymphoma carries a poor prognosis when treated with conventional chemotherapy with a one-year overall survival of 25-40%. Encouraging results have been shown with intensive chemotherapy followed by autologous hematopoietic stem cell rescue. We report the results of a large multicenter retrospective analysis of intensive chemotherapy followed by hematopoietic stem cell rescue in immunocompetent adult patients with primary central nervous system lymphoma or intraocular lymphoma after the failure of high-dose methotrexate-based treatment. DESIGN AND METHODS: Patients were included if they received intensive chemotherapy with a combination of thiotepa, busulfan and cyclophosphamide. Seventy-nine patients (median age 52.4 years, range 23-67 years) were identified. All of the patients except 5 received a salvage treatment after the failure of high-dose methotrexate. After salvage treatment and just before intensive chemotherapy followed by hematopoietic stem cell rescue, 32 patients were in complete response, 26 patients were in partial response, 2 patients had stable disease and 19 patients had progressive disease. RESULTS: With a median follow up of 56 months, the 5-year overall survival probability was 51% in the whole population and 62% among patients who were chemosensitive to the salvage treatment. The 5-year event-free survival probability was 37.8% in the whole population and 43.7% in the chemosensitive subpopulation. Neurocognitive assessments in a subset of patients suggest no evidence of intensive chemotherapy-induced neurocognitive decline. CONCLUSIONS:Thiotepa, busulfan and cyclophosphamide-based intensive chemotherapy is an effective treatment for refractory and recurrent primary central nervous system lymphoma in chemosensitive patients up to 65 years of age. The role of intensive chemotherapy followed by hematopoietic stem cell rescue in chemorefractory patients needs to be more accurately defined.
Authors: Lauren E Abrey; Tracy T Batchelor; Andrés J M Ferreri; Mary Gospodarowicz; Elisa J Pulczynski; Emanuele Zucca; Justine R Smith; Agnieszka Korfel; Carole Soussain; Lisa M DeAngelis; Edward A Neuwelt; Brian Patrick O'Neill; Eckhard Thiel; Tamara Shenkier; Fransesc Graus; Martin van den Bent; John F Seymour; Philip Poortmans; James O Armitage; Franco Cavalli Journal: J Clin Oncol Date: 2005-06-13 Impact factor: 44.544
Authors: C Soussain; F Suzan; K Hoang-Xuan; N Cassoux; V Levy; N Azar; C Belanger; E Achour; V Ribrag; S Gerber; J Y Delattre; V Leblond Journal: J Clin Oncol Date: 2001-02-01 Impact factor: 44.544
Authors: T Philip; C Guglielmi; A Hagenbeek; R Somers; H Van der Lelie; D Bron; P Sonneveld; C Gisselbrecht; J Y Cahn; J L Harousseau Journal: N Engl J Med Date: 1995-12-07 Impact factor: 91.245
Authors: Paul L Nguyen; Arnab Chakravarti; Dianne M Finkelstein; Fred H Hochberg; Tracy T Batchelor; Jay S Loeffler Journal: J Clin Oncol Date: 2005-03-01 Impact factor: 44.544
Authors: Christian Gisselbrecht; Bertram Glass; Nicolas Mounier; Devinder Singh Gill; David C Linch; Marek Trneny; Andre Bosly; Nicolas Ketterer; Ofer Shpilberg; Hans Hagberg; David Ma; Josette Brière; Craig H Moskowitz; Norbert Schmitz Journal: J Clin Oncol Date: 2010-07-26 Impact factor: 44.544
Authors: Scott R Plotkin; Rebecca A Betensky; Fred H Hochberg; Stuart A Grossman; Glenn J Lesser; L Burt Nabors; Brian Chon; Tracy T Batchelor Journal: Clin Cancer Res Date: 2004-09-01 Impact factor: 12.531
Authors: Min-Young Lee; Hae Su Kim; Ji Yun Lee; Sung Hee Lim; Eun Suk Kang; Young Hyeh Ko; Seok Jin Kim; Won Seog Kim Journal: Int J Hematol Date: 2015-12 Impact factor: 2.490
Authors: E Schorb; C P Fox; K Fritsch; L Isbell; A Neubauer; A Tzalavras; R Witherall; S Choquet; O Kuittinen; D De-Silva; K Cwynarski; C Houillier; K Hoang-Xuan; V Touitou; N Cassoux; J-P Marolleau; J Tamburini; R Houot; V Delwail; G Illerhaus; C Soussain; B Kasenda Journal: Bone Marrow Transplant Date: 2017-04-24 Impact factor: 5.483
Authors: Antonio Omuro; Denise D Correa; Lisa M DeAngelis; Craig H Moskowitz; Matthew J Matasar; Thomas J Kaley; Igor T Gavrilovic; Craig Nolan; Elena Pentsova; Christian C Grommes; Katherine S Panageas; Raymond E Baser; Geraldine Faivre; Lauren E Abrey; Craig S Sauter Journal: Blood Date: 2015-01-07 Impact factor: 22.113
Authors: Chan Yoon Cheah; Sarah Milgrom; Dai Chihara; Dan S Gombos; Chelsea C Pinnix; Bouthaina S Dabaja; Nathan H Fowler Journal: Neuro Oncol Date: 2015-10-20 Impact factor: 12.300